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Question 106
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman at 33 weeks presents with active antepartum haemorrhage. Maternal observations are stable and fetal movements are present. Which fetal assessment is appropriate once maternal assessment and resuscitative measures have commenced?
Question Stem
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Options
A
No fetal assessment unless maternal hypotension develops
B
Cardiotocography
C
Daily maternal fetal-movement chart only
D
Fetal blood sampling
E
Amniocentesis
Explanation
In women presenting with APH, fetal heart rate assessment is important once maternal assessment and initial resuscitation have commenced. CTG is appropriate when the pregnancy is sufficiently advanced for fetal heart rate monitoring and the result may influence management. Active bleeding may be associated with placental dysfunction or acute fetal compromise, so reported fetal movements alone are insufficient assessment.
Option Validity
A) Fetal assessment is indicated in APH and should not depend upon maternal hypotension developing.
C) Fetal movement reporting alone is insufficient in active APH.
D) Fetal blood sampling is not the initial fetal assessment for APH.
E) Amniocentesis has no role in routine acute fetal assessment in APH.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.